Application of transient elastometry to differentiate mild from moderate to severe liver fibrosis in HIV/HCV co-infected patients.
OBJECTIVE
Transient elastometry (TE) is accurate for detecting cirrhosis (F=4) in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infected patients. However, this procedure is less precise to differentiate mild (F < or = 1) from moderate to severe (F > or = 2) fibrosis using the cut-off value of 7.2kPa, a level previously proposed by some authors. Because of this, we elaborated and validated cut-off values of liver stiffness (LS) to better discriminate F < or = 1 from F > or = 2 in HIV/HCV co-infected subjects to aid therapy decisions.


METHODS
One hundred and ninety-seven co-infected patients with liver biopsy and TE measurement, without prior therapy against HCV infection, were included.


RESULTS
To diagnose F < or = 2, a cut-off of 9.0kPa showed a positive predictive value of 87%. To discard F > or = 2, a cut-off of 6.0kPa showed a negative predictive value of 90%. Considering all the patients, 61 (31%) patients yielded LS values < or = 6.0kPa and 81 (41%) patients showed LS values > or = 9.0kPa. There were no severe classification errors as the NPV of L < or = S6.0kPa for F > or = 3 was 100% and the NPV LS > or = 9.0kPa for F=0 was also 100%.


CONCLUSIONS
The usefulness of TE can be enhanced using two different cut-off values to identify patients with F < or = 1 and F > or = 2.
Macías
Juan
J
Clinical Unit of Infectious Diseases, Department of Internal Medicine, Seville, Spain.
Recio
Eva
E
Vispo
Eugenia
E
Rivero
Antonio
A
López-Cortés
Luis F
LF
Ríos
M José
MJ
Merino
Dolores
D
González
Mercedes
M
Barreiro
Pablo
P
de Lédinghen
Victor
V
Quereda
Carmen
C
Pineda
Juan A
JA
D000368:Aged; D001706:Biopsy; D003938:Diagnostic Techniques, Digestive System / Q000592:standards*; D004548:Elasticity; D005260:Female; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index